DermNewsletter of the American OsteopathicLine College of Dermatology Winter 2015/16 Vol. 31, No. 3

Message from the President

Greetings from Houston, Texas! As President of the AOCD, I welcome you to another edition of DermLine. I want to express my appreciation to Dr. Rick Lin, our Immediate Past President for his tireless efforts on behalf of the College. His friendship and his willingness to continue participating in a meaningful way will only make this year successful. I appreciated our time together in Orlando on a number of different levels. First, the friendships that continue and the opportunity to develop new friendships and relationships are vital to our personal growth and development. Secondly, hearing new ways of doing things, discussing similar challenges, and hearing solutions to many old challenges was powerful. Finally, I believe there are no words to describe how special Orlando was personally to me. The attendees were so very caring! There is, inherent in this great organization, a camaraderie blended with the desire to help others. The kindnesses shown to me during this conference will linger long in my memory. The year 2016 is upon us. It seems only yesterday I was entering the Kansas City University of Medicine and Biosciences in Kansas City followed by my internship and residency; these are now but distant memories. Soon another cycle will pass. New, excited doctors will emerge and enter residencies in dermatology. As director of the South Texas Dermatology Residency Program in Houston, I have borne witness to fine physicians honing their skills and expanding their knowledge in anticipation of launching their medical careers. We need to be mindful that the future of our organization rests squarely upon the shoulders of these new physicians we train. It is to the great benefit of the AOCD that we serve not only as mentors, but remain active in their development in both practice and science. Our future residents and fellows will find an exciting new development awaits them. The AOA, along with the Accreditation Council for Graduate Medical Education and the American Association of Colleges of Osteopathic Medicine, have agreed to a single accreditation system for graduate medical education programs in the United States. When the new system is fully implemented in July of 2020, the graduates of osteopathic and allopathic medical schools will complete their residency and/or fellowship education in ACGME-accredited programs and demonstrate achievement of common milestones and competencies. No longer will there be a great divide in the practical training of DOs and MDs. Clearly our world is changing! I suppose the greatest morsel I could share with you comes from one of my mentors, “Today, at this moment, we are living in yesterday’s future.” The changes in our practice of dermatology and medicine in general are profound. We spend great swaths of time dealing with electronic medical records and ICD 10. My challenge to you is to pause and remember why you chose medicine, and particularly, why you felt dermatology was to be your specialty. Then use that memory to ensure you look at your patients through that lens tinted with that memory. While we must tend to the busyness In this issue... of EMRs, we must not forget our patients. 2015 Fall Meeting Highlights and Notes I look forward to serving you and the opportunity to meet all of ...pages 6-23 you as you attend our meetings. Foundation for Osteopathic Dermatology Alpesh Desai, DO, FAOCD Update...pages 24-25 President, American Osteopathic College of Dermatology AOCD Thanks 2015 Fall Meeting Sponsors and Exhibitors...pages 26-27 Message from the Past President It has been an amazing seven-year journey. It was approximately seven years ago when I was first elected a Trustee of the AOCD Board of Trustees on a last minute floor nomination. It seemed like a good idea at the time. My practice was growing and I was looking for another challenge.

Dr. Jim Young’s installation as the AOCD President had a lasting impression on me as a student member. Later, my own Program Director and role model, Dr. Bill Way, became the President. My admiration for the leaders of the College paved the way for me to aspire for a higher office beyond Trustee.

I also have to confess the aspiration was not consistent throughout. After I was accepted into a residency program, a certain amount of complacency set in. After three years of being a dermatology resident, the excitement slowly started to fade. It’s mandatory to attend the Presidential Banquet, which is a long night. I remember thinking that I couldn’t wait for it to be over so I could find out where Dr. Shino Bay was going to party that night. He always seemed to know where the best parties were.

Throughout my years as a Trustee and officer of the AOCD BOD, there were many discussions and disagreements among the Board members. Discussions can get heated at times, resulting in hurt feelings and bruised egos. Occasionally, the issues discussed can be very stressful. Sometimes, I didn’t even know if everything I was doing as an AOCD officer was making any difference. I was not sure if it was all worth it.

During the last few years leading up to be the presidency, I gradually understood the value of what I was doing. When I attended the American Academy of Dermatology (AAD) Gala and the Mohs Surgery Summit on behalf of the AOCD, I met with the upper echelon of leaders within the AAD. These wonderful leaders of organized dermatology welcomed me to the table for discussions and listened to what I had to say. I realized the reason why I was being treated with respect by these amazing leaders of dermatology is not because Rick Lin is awesome. After all, I am just a country doc practicing in a border town. I was being treated with respect because of who I was representing. Because the members of this College empowered me to represent them, I was speaking with other leaders on equal terms. As the AOCD President, it was no longer just about me anymore. It was, and is, about honoring all the College leaders before me and paving the way for the leaders after me.

During the past seven years, I have learned to respect the office and our College. Everything we do, whether it’s the long drawn out Board of Trustees and Business meetings or the President Celebration, it’s about paying homage to all the past and present AOCD members and leaders. It is not just a bunch of us old guys patting each other on the back. Through everyone’s dedication, there exists this institution that provided me the opportunity to become the dermatologist I am today. The AOCD has enabled me to do what I love every day and provide for my family just as it has done for countless other AOCD members.

I share my thoughts on this because I would like to encourage all of our younger members and residents to always keep an appreciation and admiration for this College, and to have the aspiration to be part of the AOCD leadership. And to one day, contribute your own energy and talent for the betterment of the College.

My seven-year journey to the end of this presidency, of course, has not occurred without personal sacrifice. I have traveled frequently for the AOCD, leaving my wife at home to stay with our three young daughters. I am thankful to my wife for allowing me to sacrifice some family time to fulfill my duty to the College.

I also want to mention my mother. Without her, I would not have been able to achieve my dream of being a dermatologist. She has been a role model to me and has instilled in me the values and work ethic of striving to be the best that I can be. I am forever thankful to her for everything.

Page 2 To round up this year, I would like to thank Marsha and the AOCD staff for a year of hard work. I also want to thank my Board members for making this a memorable year for me.

There are many changes coming our way and we are sailing in uncharted water. During the next five years, the very mission and essence of the AOCD will be tested. Our relevance will be evaluated. Without careful planning and foresight, we may be deemed obsolete.

The Accreditation Council for Graduate Medical Education (ACGME) is slated to take over the AOCD’s role in graduate medical education. There are many misunderstandings, even within our membership, about the implications of this merger. Some of our members believe the merger will confer ACGME or MD board certification on us, and with that automatic AAD fellowship status. Nothing is further from the truth. The ACGME merger will leave us to be the group that is left behind. All of us with AOBD board certification now and in the future, will rely solely on the AOBD for future recertification. At this point, we are not eligible for recertification by the American Board of Dermatology.

With the ACGME merger, we will likely see the AOCD become a much smaller organization in the course of the next five to 10 years. The current pipeline of 50 AOCD residents every year may not be relying on the College for continuing medical education credit IF the future osteopathic dermatology residents choose not to take the DO board examination. Consequently, the growth of the AOCD may be stunted. As an organization, we will need to re-invent ourselves and modify our vision to ensure our future survival. We will need the SUPPORT of ALL our members, young and old, to lead our College to new prosperity. To do so, we will need the participation of everyone involved. Our heritage and our own ability to practice dermatology are intimately tied to the survival of the AOCD.

In summary, we are our survival. We will need dedicated members and visionary leaders to guide us through the challenges. Incoming AOCD President Dr. Alpesh Desai is one of those leaders.

I remember the first College meeting I attended as a first-year resident. Dr. Desai was on stage giving one of his Koprince award presentations. That was more than 12 years ago. Most of the resident lectures at the time were case reports. But there was Alpesh presenting his original research on tomoxifen and its potential application in the treatment of Melasma. The audience was dazzled! He had this Powerpoint presentation with all the animation and moving parts showing the mechanism of action.

I remembered that very moment telling myself that I must become his friend. This man is going places! I must follow him and ride the coattails of his success... because he is bound to be very successful. I was absolutely right.

During the past 12 years, I have learned a lot from Alpesh. He gives advice with many insights and has helped me out of many tight spots. Recently, I had the honor of becoming a dermatology residency Program Director. For five years leading up to this opportunity, Dr. Desai allowed me to be the Assistant Program Director at his Houston residency program. It was in that role that I was able to gain confidence and experience teaching residents, enabling me to accept a directorship position when the call came.

Alpesh is not just a friend to me; he also is my mentor and advisor. He is a man who possesses wisdom and great judgment. And while I leave the College in GREAT hands under his leadership, I urge each and every member to pay their dues, attend our meetings, participate in committees, and help keep the AOCD vibrant.

Rick Lin, DO, MPH, FAOCD Immediate Past-President, American Osteopathic College of Dermatology

Page 3 Line DermNewsletter of the American Osteopathic College of Dermatology Executive Director’s Report Board of Trustees by Marsha Wise, Executive Director PRESIDENT Alpesh Desai, D.O., FAOCD Greetings to approve these recommendations and are PRESIDENT-ELECT Karthik Krishnamurthy, D.O., FAOCD Everyone! submitting to the general membership for FIRST VICE-PRESIDENT a formal vote. An announcement was made Daniel Ladd, D.O., FAOCD 2015 has at the AOCD General Business meeting on SECOND VICE-PRESIDENT been a Friday, October 16, 2015, and again during John P. Minni, D.O., FAOCD busy year. the Presidential Celebration that same evening. THIRD VICE-PRESIDENT The changes are as follows: Reagan Anderson, D.O., FAOCD Where do IMMEDIATE PAST-PRESIDENT we go AOCD By-Laws Rick J. Lin, D.O., FAOCD from here?? Article II, Board of Trustees and TRUSTEES Standing Committees Danica Alexander, D.O., FAOCD The single- Section 1: Voting Members David Cleaver, D.O., FAOCD Tracy Favreau, D.O., FAOCD unified The voting members of the Board shall consist Peter Saitta, D.O., FAOCD accreditation system is moving forward. By of the President, President-elect, First Vice Amy Spizuoco, D.O., FAOCD June 30, 2020, the AOA will no longer accredit President, Second Vice President, Third Vice Michael Whitworth, D.O., FAOCD residency training programs. What will be President, Secretary Treasurer, Education SECRETARY-TREASURER Steven Grekin, D.O., FAOCD the trickle-down effect of this? How will Evaluation Committee Chair, Finance Committee Chair, EXECUTIVE DIRECTOR osteopathic medicine and our specialty college Immediate Past President, Marsha A. Wise, B.S. as well as others remain relevant? No one six (6) trustees and an appointed representative knows! What we do know is, this is something of the American Osteopathic Board of Editorial/Public Relations Committee we all need to start working on now. Dermatology. In addition, the Executive CHAIR Director, and the Resident Liaison shall attend David Cleaver, D.O., FAOCD At the recent AOA Advocacy for Healthy all meetings of the Board of Trustees as non- DERMLINE EDITOR Partnership meeting, topics on promoting voting members. Danica Alexander, D.O., FAOCD osteopathic medicine and advocating for DERMLINE ASSOCIATE EDITOR Marsha Wise osteopathic equivalency were presented. The Rationale: Removing the Finance Committee MEMBERS Dermatology World article from June 2015 Chair’s ability to vote on BOT matters. Danica Alexander, D.O., FAOCD on “Defining the DO” was one success story Committee members felt the committee should Jason Green, D.O., FAOCD shared at the meeting which was attended by remain neutral in order to provide oversight. Susun Kim, D.O., FAOCD physician leaders and executive directors from Albert Rivera, D.O., FAOCD Lawrence Schiffman, D.O., FAOCD various state societies and specialty colleges. AOCD Constitution Dustin Wilkes, D.O., FAOCD Click here to read the article. Article III, Membership

Corporate Partners Section 2.A DIAMOND In October, the AOA launched a brand Fellow: Any osteopathic OR ALLOPATHIC Galderma awareness campaign. Through the spring of physician who has been certified by the Sun Pharma Valeant Pharmaceuticals 2016 you can expect to see these ads in both AOA through the AOBD, or certified GOLD print and video. Click through the ABMS by AbbVie here to learn more the ABD shall be eligible Celgene about this campaign. for fellow membership. Merz Pharmaceuticals, LLC Fellow members shall SILVER Lilly USA, LLC How will the AOCD have full membership BRONZE prepare for the rights which include Anacore Pharmaceuticals future? Just like the specifically, the right to Dermatopathology Laboratory of Central States American Academy vote, to hold office, to PEARL Actavis, PLC of Dermatology, be assessed dues, and Allergan the AOCD is also to accept appointment Dermpath Diagnostics DUSA Pharmaceuticals preparing for a By- to committees and Laws change. councils. He/She Contribute to DermLine must be a member If you have a topic you would like to read about or an article you would like to write for the next issue of On Thursday, October in good standing of DermLine, contact Marsha Wise by email at 15, 2015, the AOCD the AOA. Failure to [email protected] or John Grogan at [email protected]. Board of Trustees met maintain membership American Osteopathic College of Dermatology and discussed a By- in the AOA or Canadian P.O. Box 7525 2902 N. Baltimore St. Laws change and a Osteopathic Association Kirksville, MO 63501 Constitution change. will be due cause to lose Office: (660) 665-2184 | (800) 449-2623 Fax: (660) 627-2623 The committee voted membership and listing Web: http://www.aocd.org http://www.aobd.org Flat Stanley’s 2015 Fall Meeting Scrapbook

Honorary AOCD Staff Member, Stanley Lambchop, a.k.a. “Flat Stanley,” was adopted from Mrs. Kimberle Burnett’s Third Grade class at Corse Elementary School in Burlington, Iowa. Stanley Lambchop had a big bulletin board fall from the wall above his bed, flattening Stanley in his sleep. He survives and makes the best of his altered state. One special advantage is that Flat Stanley can now visit his friends by being mailed in an envelope.

Mrs. Burnett’s third grade class in the annual directory of the American Osteopathic College with the AOCD and your password is “Aocd” followed by your AOA#. of Dermatology. (case sensitive) Please contact our office if you have difficulty logging in.

Rationale: To allow Allopathic physicians to become Fellows in the Also on that page is a form to update your database information. This AOCD. This is being done in anticipation of the Spring AAD vote database is maintained on our web site so you can make changes to which, if passed, will allow Osteopathic members certified by the your membership information at any time. All changes you make will AOBD to become full fellows in the academy. be recorded in the database and will also update the “Find a DO” section of the web site. Although you will see all of your information Members have been asked to vote on whether to allow allopathic in your personal file, all inquiries will only see your office address, board certified dermatologists to become Fellows in the AOCD. An office telephone and fax number. electronic ballot was presented to the membership on December 4, 2015. Members had until December 9, 2015 Reminders to respond. The AOCD Membership approved December 31, 2015 is the end of the current CME this change with 91% of votes submitted in cycle. The new cycle begins January 1, 2016. I favor and 9% votes submitted against. encourage everyone to check your CME reports and to monitor the AOA site for the new CME guide This is not quite official, as the next step is which has not been published. We are hearing that to submit to the AOA Board of Trustees for there will be changes in the requirements for the final approval. We should have the AOA’s new cycle. Click here to find that information. decision by the end of February 2016. Many AOCD members have been inquiring about OCC and What other changes will take place for the AOCD? The CME OCAT. Click here to register, if you have not already done so. This committee is exploring online CME. A proposal will be presented is all mandatory for recertification. If you have any questions please to the Board of Trustees at their meeting in New York. Currently, refer to the AOBD website. the AOA allows up to nine online CME per cycle; however, this number may go up. Save the Dates! • The 2016 Spring Meeting will take place from March 30- April How can you as a member help? Get involved! Consider joining a 3, 2016 at the Ritz Carlton Battery Park, New York, NY committee, attend our CME sessions and most importantly, remain • The 2016 Fall Meeting will take place from September 15-18, current on your AOCD dues. Your annual dues are important to 2016 at the Loews Santa Monica, Santa Monica, California. the AOCD. They provide the majority of the funding for our CME • The 2017 Spring Meeting will take place from March 29- April conferences as pharmaceutical funding continues to decline. 2, 2017 at the Ritz Carlton Atlanta at 181 Peachtree Street, Northeast in Atlanta, GA. Renew your AOCD membership dues for 2016 now. The AOCD has made it easier for you to renew your dues by providing a link to our As always, if you have questions or concerns, please feel free to website for quick and secure renewal. Go to our web site, http://aocd. contact me (see “Contact Us” at AOCD.org), and I will be happy to org. To log in, your username is your email address you have on file assist you. We appreciate your continued support of the AOCD.

2015 AOCD Fall Meeting Highlights

• “Frosting” after tattoo removal • Lysis of ink bonds • Microscopic carbon dioxide bubbles underneath epidermis • Petechiae takes place only where the ink is • Selective photothermolysis • Term used when treatment directed at removing chromatophore (ex. tattoo removal; hair removal) • Pre-care • Sun avoidance • No isotretinoin six months before • Not performed on pregnant patients (no studies have been done, nor will they likely be done on pregnant women) • Post-care Laser Tattoo Removal • Ice off and on Will Kirby, DO, FAOCD • Moisturize • Physics behind • Avoidance of activities that would increase body heat • Audible “pop” during tattoo removal is the sound barrier • No popping of blisters being broken

Page 6 • Follow up with provider if suspected infections—do NOT go inflammation; pulse clobetasol topical solution; 50-60% to ER after tattoo removal could be potential transplant patients • Have patients fill out online survey after treatment • Pseudopelade of Brocq • Consultation recommendations • Central Centrifugal Cicatricial Alopecia (CCCA) • Three “P’s” of any procedure • Lymphocytic attack of hair follicles • Pain, Procedure, Price • More progressive even after it appears to stabilize • “How many treatments does it take to remove a tattoo?” • Etiology unknown • Kirby-Desai Scale—takes six different parameters to • Goal is to stabilize patients determine number of treatments based on skin type, • 20% could be potential transplant patients location, colors, amount of ink, scarring and tissue change, • Treatment: similar to LPP and layering tattoos • Symptoms: hyperpigmentation, scalp can be smooth and • Q&A shiny, pins and needles, pruritus, tenderness • For a tattoo to be permanent it has to reside in the dermis • Neutrophilic • Pustular eruption of the scalp Female Hair Loss • Dissecting cellulitis: African-American men 18-40 years old; Matt Leavitt, DO, FAOCD multifocal disease with interconnecting tracts treatment is oral steroids • Mixed cell scarring alopecias: folliculitis keloidalis • Non-scarring • Telogen effluvium • Visible and rapid progression of hair loss • Most common causes are post-partum, medication, stress (diet), thyroid disease • Shedding of hair vs. thinning of hair, which is more commonly associated with female pattern hair loss (FPHL) • Miniaturization: shortening of hair cycle; rapid turnover • Root of hair appears bulbous or onion-shaped • Treatment: clobetasol solution; injections to parietal areas of present; low level light therapy; minoxidil 5% • Workup: primarily history and exam; labs include CBC, CMP, TSH, FSH/LH, testosterone, DHEA-S, iron, iron binding capacity, transferrin, ferritin • Introduction • Alopecia Areata • Profile of female hair loss • Find hair breakage in clinical exam; exclamation point hairs • Psychosocial impact (distal tip larger than proximal tip) • Not many female role models with hair loss • Treatment: as it is a lymphocytic infiltrate treatment, treat • Etiology the inflammation—pulsed steroid; superficial kenalog, • Most women should have thorough workup as there are minoxidil 5% many etiologies • Chemical alopecia • Scarring vs. non-scarring • Trichotillomania: ask patient why they are “scratching their • Non-scarring: Diffuse and focal (ex. telogen effluvium, scalp,” and come up with a reason to treat scalp alopecia areata, traction alopecia) • Androgens – Women • Scarring • Women can have baldness in presence of normal and high • Cicatricial alopecia (destruction of follicle) androgen levels • Primary scarring alopecia classification: lymphocytic (most • Pattern is different in women common; ex. discoid lupus erythematosus), neutrophilic • “Thinning” problem more than a balding problem (most obvious), mixed, non-specific • Women treated with aromatase inhibitors experience FPHL • Lymphocytic • Slow onset and progression; hair loss is from root • Lichen planopilaris (LPP) • Most follow Ludwig Pattern with widening part • Females 40-60 years old • Miniaturization • Unknown etiology • Treatment • Defining lesion: leading edge is perifollicular • Minoxidil 5% (opens potassium channels; vascular endothelial erythematous/violaceous papules and spinous/follicular growth factor (VEGF); cell proliferation; apply when skin is dry) keratotic papules • Spironolactone (reduces androgen levels; start at 50mg) + • Atrophic, smooth shiny patches clobetasol (pulse) will slow down FPHL • Slowly progressive disease; must attack it quickly • Low level laser therapy: emits red light with wavelength • Variant: frontal fibrosing alopecia (band across scalp) in 630-670; minimal time commitment women under 40 years old • Female hair transplant assessment • Treatment: superficial 1-2cc Kenolog 10 injections every • Women often require more “listening” from physicians than three to four weeks; low-dose doxycycline short-term for “talking” during pre-op consultation

Page 7 Baseline1,* Hour 41,* Instant gratification.2,† Introducing Neotensil™—the only noninvasive solution that reduces the appearance of under-eye bags, within an hour.3,‡

Brought to you exclusively by Obagi Medical Products

To order, contact your Obagi sales representative today or call 1.800.636.7546. For more information, visit www.obagi.com.

*Photos have not been retouched. Results may vary. †Study results for one application of Neotensil in a 16-hour durability study; 4% of patients saw results within 10 minutes and 70% of patients saw results within 1 hour; N=28. ‡Study results for once-daily application of Neotensil in a 2-week pilot study; N=25. References: 1. Data on file, Living Proof, Inc.2. Draelos ZD, Investigator. Strateris 16-hour durability study, DCS-105-13. Data on file, Living Proof, Inc. 3. Kauvar A, Kilmer S, Ross EV, et al. A pilot study of a novel non-invasive topical under-eye contouring technology. Poster presented at: 71st Annual Meeting of the American Academy of Dermatology; March 1-5, 2013; Miami, FL. Neotensil and Living Proof are trademarks of Living Proof, Inc. used under license. Except as otherwise indicated, all other product names, slogans and other marks are trademarks of the Valeant family of companies. Distributed by OMP, Inc. ©2014 Obagi Medical Products, Inc., a division of Valeant Pharmaceuticals North America LLC. DM/NEO/14/0008c 03/14 • Ask how patient currently styles her Benign or Malignant: What Does the • Breslow thickness and ulceration are the hair and how she hopes to style it in Pathology Say? most dominant predictors of survival the future John Cangelosi, MD • Mitotic rate also plays a role in staging • Look at hair characteristics (color • CD4:CD8 ratio greater than 3:1, • Chromohyphomycosis texture, skin-to-scalp contrast, level consider malignant process • Infection by a fungal family Dematiaceae of curl) • CD4+ small medium sized pleomorphic • Fungi with brown septated hyphae • Warn patients that for the first few t-cell lymphoma • Decomposing vegetation and soil months will likely have more trouble • Rare, usually asymptomatic • Trauma usually gateway to infection styling than before • Solitary plaque or nodule on face, • Extrammammary Paget’s disease neck, upper trunk • Most are in situ malignancy derived Solo Strategies: The Future is Still Bright • Favorable prognosis from intraepidermal sweat ducts Daniel Ladd, DO, FAOCD • Benign lichenoid keratosis • Minority are epidermotropic • Comfort level • Short duration metastasis from distant malignancy • Working longer hours • Predilection for face, forearm, • One-third of perianal lesions are • Financial risk dorsal hand associated with a • What’s your personality? • Predominantly Caucasian rectal adenocarcinoma • Patients are more concerned whether • More common in females than males • Overall association with internal their ailments can be cured rather than • Paget’s disease malignancy is 15% the name of the illness • + CK7, - CK5/6; Her2/Neu • Spitz nevus • Important decisions • Almost always associated with breast • Benign melanocytic nevi • Buying an existing practice vs. starting carcinoma • 50% in children under ten years old a new practice • Results from tumor spread via • 70% diagnosed during first two • Embracing new technology lactiferous ducts to the decades of life • Key decision—choosing an surface epithelium • Differential includes atypical Spitz office manager • Usually unilateral presentation tumor and Spitz-type melanoma • Location • Folliculotrophic mycosis fungoides • If older patient, additional molecular • Rural vs. urban • Preferential location is head and neck tests may be needed such as the • Urban/metropolitan areas • Follicular mucinosis NeoSITE Melanoma Test Proprietary • Business starts slow due • Usually minimal epidermitropism FISH test to competition • Worse survival rate than classic • Homozygous loss of 9p21 • City size mycosis fungoides (Spitzoid melanomas) • Business plan • Psoriasis • Gain of cMYC locus at 8q24 • You must have a long term plan in • Arthritis in one-third of patients (amelanotic melanoma) order to be successful • Least common on face • Gene amplification at CCND1 • Important to think like a business • Basal cell nevus syndrome region on 11q13 and RREB1 region person rather than a physician • Autosomal dominant on 6p25 • Very important to find a good office • Early onset, multiple Basal cell • Cutaneous lymphoid hyperplasia (CLH) manager carcinomas (BCC) • Also known as “Pseudolymphoma” • You must manage this person and • Odontogenic keratocysts, • B-cell (typical CLH, angiolymphoid they will manage the office palmoplantar pits, falx cerebri hyperplasia, Kimura’s and • Visit and meet every doctor in your area calcifications, medulloblastomas, Castleman’s diseases) • Helps to establish relationships so hydrocephalus, cataracts • T-cell (T-cell CLH, lymphomatoid that you can get referrals • Mutation of chromosome 9 in the contact dermatitis) • The “connection” is more important PTCH gene • Both may represent exaggerated than selling them anything • Should consider biopsy of acrochordon- reactions to external antigens • Changing landscape like lesions in young patients • T/B cell gene rearrangement studies • The increasing number of older • Amelanotic melanoma can help patients (including baby boomers) • Mart-1/Ki67 • Follow for persistence at site or is going to increase the demand for • Characterizes melanocytic and evolution of lesions elsewhere treating skin cancer lymphocytic proliferation of cells • Desmoplastic melanoma • Demand of treatment is greater • HMB45 melanocytic marker • Rare variant of spindle cell melanoma than supply • If retained past superficial layer is a • Sun damaged skin in elderly • Healthcare delivery issues worrisome sign • Uncommon—less than 4% • Surface radiation • 5% of melanomas of melanomas • Offer patients the option for surface • Often misdiagnosed as eczema, • Different clinical behavior than radiation alone or in combination seborrheic keratoses, Bowen’s, BCC, normal melanomas with Mohs angiofibromas, etc. • High tendency for persistent local • Important to establish a relationship • Often leads to poor prognosis when growth and less nodal metastasis with a radiation oncologist diagnosed late • Five-year survival from 70-90% • Referrals can go both ways

Page 9 Update on Androgenetic Alopecia: Surgical and Non-Surgical Treatments • Disadvantages Shelly Friedman, DO, FAOCD • Graft quality is not as good compared to FUT • More fragile • Size of single surgery is much more limited • Usually more expensive than FUT • Possible to transplant eyebrows • Warn patients they will need to trim their eyebrows more than usual • New studies are showing though that the eyebrow transplants are starting to grow less, adapting to their new site • Non-surgical treatments • Low level laser therapy (LLLT) • MOA • Photons act on cytochrome c oxidase producing an increase in ATP, resulting in a release of energy and stimulation of the metabolic processes required for hair growth. • Androgenetic alopecia • Also releases nitric oxide, resulting in an increase in scalp • Autosomal dominant, variable penetrance blood flow • Approximately 40 million men and approximately 30 • Long term effects of LLLT million women • Increases cell survival • Sensitivity to androgen (versus having too much androgen) • Reverses follicular apoptosis • History of hair restoration surgery • Reduces inflammation • In 1939, Japanese ophthalmologist, Dr. Shoji Okuda, • Increases the anagen phase and decreases the performed first hair transplant telogen phase; • In 1952, dermatologist, Dr. Norman Orentreich, performed • Increases hair tensile strength first American hair transplant • Reverses miniaturization • Hair transplant principle for androgenetic alopecia • 630-670 nm wavelength • Donor dominance: hair follicles maintain characteristics • Decrease in hair loss is usually noticed in first six months, from the area it was taken from regardless of where in the after which they may see return of miniaturized hairs scalp it is placed • CCCA: can increase growth of surrounding hair to give • Recipient dominance: hair follicles when transplanted into a camouflage to areas of hair loss diseased recipient area will be affected by what damaged hair • Pharmaceutical treatments follicles in first place • Minoxidil • Follicular unit transplantation (FUT) • Direct stimulator of follicular growth via VEGF and • Hair transplanted from permanent zone where hair follicles prostaglandin synthase are more resistant to balding • Stimulates proliferation of dermal papilla cells • Donor harvesting: • Opens adenosine sensitive potassium channels in the 1. Shave area dermal papilla of the hair follicle 2. Excise strip • Finasteride 3. Suture close with continuous running stitch • Inhibits action of Type II 5-alpha reductase 4. Techs cut into follicular units • Stops or slows future hair loss • Grafts placed in coronal orientation and densely packed • Spironolactone • Graft insertion • Slows down production of androgens in the adrenal • Post Op glands and ovaries • Shampoo and place occlusive ointment to prevent scabbing • Therapeutic dosage between 100-200 mg daily • Laser therapy can also provide anti-inflammatory due to leukocyte inhibition Osteopathic Review in Dermatology and Practice Management • Follicular unit extraction (FUE) Suzanne Sirota Rozenberg, DO, FAOCD • Method of graft harvesting in units • Applying Osteopathic Principles to the Diagnosis and Treatment • ARTAS system of Dermatologic Diseases (key points) • High resolution digital imaging • Don’t be afraid to touch the patients • Minimally invasive • Principle 1: “The body is a unit” • Advantages • Mental illness may be first displayed as a skin condition • No linear scar in donor area • It is important to consider psychiatric evaluation of certain • Decreased healing time in donor area patients because they may not be aware that their mental • Virtually no limitations on strenuous exercise post-op condition may be affecting skin conditions • Useful for patients with a greater risk of donor scarring • Principle 2: “The body is capable of self-regulation, self-healing, (younger patients or very muscular patients) and health maintenance”

Page 10 From hard-to-reach spots to large body areas... We’ve Got

You Covered®

ube with Spray T

Triamcinolone Acetonide

Topical Aerosol, USP (0.147mg/g) 1 The Only Triamcinolone in an Aerosol Spray Formulation cools skin; decreases itch Minimal ingredients -- vehicle contains isopropyl palmitate (a moisturizer); low dehydrated alcohol content No touch, precise application at any angle Available in Delivers 0.2% triamcinolone* 63 g and 100 g sizes Relief Never Felt So Good Indication: Kenalog® Spray (triamcinolone acetonide topical aerosol, USP) is indicated for relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. Important Safety Information: Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing’s syndrome, hyperglycemia, and glucosuria in some patients. Conditions which augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings. Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity (see PRECAUTIONS, Pediatric Use). You are encouraged to report negative side effects of prescription drugs to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch For topical use only. Please see adjacent page for full prescribing information. For more information, visit www.kenalogspray.com Reference: 1. Data on file. Ranbaxy Laboratories, Inc. Princeton, NJ. * After spraying, the nonvolatile vehicle remaining on the skin contains approximately 0.2% triamcinolone acetonide. Each gram of spray provides 0.147 mg triamcinolone acetonide in a vehicle of isopropyl palmitate, dehydrated alcohol (10.3%), and isobutane propellant. KENALOG® is a licensed trademark of Bristol-Myers Squibb Company. KS 1212

Kenalog Derm Times 5-9-13 indd.indd 1 5/9/13 7:25 AM • Prevention of skin disease is a key aspect of treatment • Until OCC was developed, physicians maintained their • Sometimes medical intervention is the only way to certification through participation in CME activities and taking encourage homeostasis so that the body can begin to clear recertification examinations certain disorders • External factors in the past decade made it apparent that • Principle 3: “Structure and function are interrelated” osteopathic physicians must consider performance evaluations • Principle 4: “Rational treatment is based on understanding of as part of its process the 3 main principles” • Influencing factors on the development of OCC • Osteopathic Manipulative Treatment • Institute of Medicine reports on quality care • Certain skin disorders may be treated by OMT • Patient perception • Neurocutaneous disorders • Allopathic Maintenance of Certification (MOC) • Edematous conditions • AOA Clinical Assessment Program • Conditions with pruritus • Performance improvement initiatives • Why OCC/MOC? Practical Practice Management • Responsibility of the profession to the public Suzanne Sirota Rozenberg, DO, FAOCD • Self-regulation dependent on effective and credible assessment • Maintain competence • The real goal is continuous improvement • Assessment drives learning • How will OCC affect me? • It is voluntary for non-expiring certifications • Fulfill any maintenance of licensure requirements • Publicly demonstrate commitment to ongoing quality and assessment • Continuous certification goals • High standards of patient care • Provide physicians ability to asses and improve abilities • Transparent to public and communicate info about physician competence • Five Components of OCC to maintain licensure • Negotiate 1. Unrestricted licensure • Negotiating payments and leases will reduce costs • One of the 50 states or Canada • Negotiate with staff their expected responsibilities so that you • Adherence to AOA Code of Ethics don’t need to micro-manage them 2. Lifelong learning/CME • Location • Minimum of 120 CME credits for every three year cycle • The best location might not be where you want to practice with 50 of them in the specialty area of certification • Must take into account population dynamics and the number 3. Cognitive assessment of other practices in the area • Specialty board exams must be taken every ten years • Office Meetings 4. Practice performance assessment and improvement • Know the names of your patients and staff • Compares osteopathic physicians’ current practice with that • Makes them feel like an individual instead of just of national benchmarks for the specialty another number 5. Continuous AOA/AOCD membership • Don’t be afraid to delegate • Core competencies • Specialty Services • Osteopathic philosophy and osteopathic manipulative medicine • Know whether drug representatives are a nuisance or whether • Medical knowledge they are helpful • Patient care • Interpersonal and communication Osteopathic Continuous Certification (OCC) • Professionalism Lloyd Cleaver, DO, FAOCD • Practice-based learning and improvement • AOA Certifications • Systems-based practice • An osteopathic physician must first hold a primary • OCC summary certification in their primary specialty • Assures high standards for patient care • The physician may then complete a fellowship to achieve • Demonstrates commitment to continuous improvement a Certification of Added Qualifications (CAQ), which • Is practice-relevant cannot stand alone, and the physician must maintain their • Ensures osteopathic excellence primary certification • After completing a fellowship, a physician may choose to Great Cases from Osteopathic Institutions obtain additional a certification of special qualifications • Cindy Hoffman, DO, FAOCD: NYCOM/St. Barnabas Hospital (CSQ), and they may then choose to only maintain the CSQ • Interesting cases with unique treatments and allow their primary certification to expire • Chronic red eruption with gammopathy

Page 12

• Histology showed urticarial dermatitis with • Differential diagnosis: Madelung’s disease: benign rare neutrophils symmetrical lipomatosis, fibromyalgia, familial multiple • Atypical bi-clonal variant of Schnitzler syndrome lipomatosis, lipoedema, panniculitis • Failed treatment with anakinra but was receptive • Diagnosis: patient history; clinical presentation; to tocilizumab unenhanced MRI can demonstrate “blush-like” findings • Generalized annular eruption • Treatment: non-specific; symptomatic; bariatric surgery; not • Disseminated granuloma annulare many good treatment options; psychotherapy • Treated with adalimumab • Chronic, non-healing ulcer • Dawn Sammons, DO, FAOCD: O’Bleness Memorial Hospital • Osteoma cutis • Ten days of worsening rash • Treated with sodium thiosulfate injections • Presented to ER where they gave him ten day course of prednisone which has not helped • Matthew Elias, DO, FAOCD: PCOM/North Fulton Hospital • Rash worsens despite prednisone and lengthened taper • Bug beneath bathing suit: seabathers eruption of CLM • Differential diagnosis: zoophilic fungal infection, bullous • Papular urticarial/arthropod assault on biopsy sweets, B-cell lymphoma • Located directly beneath swimsuit (versus “swimmer’s itch” • Biopsy confirmed: bullous sweets which is on exposed skin) • Positive anti-saccharomyces cerevisiae: both IgA and • CLM: hookworm infection; confined to epidermis in IgG titers (very specific for Crohn’s disease but no humans and have migrating, serpiginous tracts. Biopsy will clinical symptoms) usually be negative because it will not “catch” the worm • Treatment: IV solumedrol during hospital stay and • Treatment: ivermectin transitioned to dapsone outpatient • Three types: classic/idiopathic; malignancy associated; • Stephen Kessler, DO, FAOCD: LECOM/Alta dermatology drug induced • Pityriasis rubra pilaris • Classic findings: fever, anemia, neutrophilia, classic • Histology: Thin preserved granular layer; thick club shaped skin lesions rete ridges; thick suprapapillary plates; alternating ortho- • Painful, erythematous, popular and nodular lesions most and parakeratosis common, bullous lesions can form or be predominant • Treatment: • Treatment: first line is prednisone (1 mg/kg/day); second 1. Topical steroids, topical vitamin D3 analogs, tar line is dapsone and cyclosporine shampoos without improvement 2. Trial of methotrexate at 5 mg once weekly but • Robin Shecter, DO, FAOCD: West Palm Hospital discontinued as patient couldn’t tolerate • Recurring hyperpigmented patches on face over past year; 3. Acitretin at 25 mg daily and emollients but patient relapsing and recurring couldn’t tolerate side effects • Shave biopsy: interface vacuolar changes with 4. Ten days of 0.75 mg of dexamethasone but experienced dermal melanophages extreme side effects • Diagnosis: fixed drug eruption 5. Increased Acitretin dose with alternating 50 mg and • History of recreational use of marijuana 25 mg • Form of drug allergy that presents as single or multiple 6. Decreased dose of acitretin round sharply demarcated dusky red lesions several 7. Initiated adalimumab with acitretin taper but did not centimeters in diameter that occur at the same sites after experience improvement for two months each administration of the inciting drug 8. Developed facial rash which was cultured as • Bactrim/Trimethoprim-sulfamethoxazole is most staphylococcus and treated successfully with cefalexin commonly implicated successfully • Differential diagnosis: insect bit reactions, PIH, tinea, 9. Ultimately, decreased treatment of acitretin to 10 mg contact dermatitis, cellulitis with improvement • Diagnosis: patch test; provocation test • Treatment: stop suspected drug; topical steroids and • Jenifer Lloyd, DO, FAOCD: UH/ Richmond Medical Center systemic antihistamines; systemic corticosteroids • Dercum’s Disease (for bullous) • Multiple painful, fatty tumors and growths • Generalized overweight/obesity with chronic, painful • Daniel Stewart, DO, FAOCD: St. Joseph Mercy Health System adipose tissue • Stewart-Treves Syndrome on the Lower Extremity • 98% of patients had pain; all had easy bruisability • Elderly female with painful bleeding cutaneous lesions in • Greater than three months, symmetrical and disabling, the lower extremity with past medical history significant for burning or aching feeling diabetes mellitus and chronic kidney disease • Varies from discomfort on palpation to paroxysmal attacks • Histology: epithelial hyperplasia and marked diffuse of pain hemorrhage; interanastomosing vascular channels. • Etiology is unknown; most cases appear spontaneously CD31 stain positive: atypical endothelial cells lining the • More common in females than males; 35-50 year old onset endothelial lumen

Page 14

• Diagnosis: cutaneous angiosarcoma • Autosomal dominant inheritance age. However, patient experienced in the setting of chronic • Tumor predisposition syndrome multiple lesions on left lower leg lymphedema (Stewart-Treves • Distinct melanocytic tumor with one week after radiation Syndrome), a rare aggressive flesh-toned to reddish-brown • Causes of KA: UV damage, malignant vascular tumor papules. Histology illustrates trauma, drug exposure, genetics, • Location: head and neck (50% predominantly intradermal post-radiation cases); prior radiation sites; collection of large epithelioid • Treatment of cutaneous chronic lymphedema cells with abundant eosinophilic malignancy with intralesional • Non-healing eschar, palpable cytoplasm, nuclear pleomorphism injection: interferon, 5FU, subcutaneous masses and prominent nucleoli methotrexate, bleomycin • Treatment: wide local excision/ • Consider injection when surgery/ amputation, radiation, • Adriana Ros, DO, FAOCD: Palisades radiation are contraindicated; also chemotherapy, mean overall survival Medical Center consider when treating cosmetically rate is 2.6 years • Subepidermal mucocutaneous sensitive areas bullous dermatoses in renal cell • Schield Wikas, DO, FAOCD: LECOM/ transplant patient The Art of Radiotherapy: Skin Cancer Tri-County Dermatology • Treatment: IV methylprednisolone Removal Without a Trace • Pustular tinea ID reaction at 30mg BID David Herold, MD • Autoeczematization reactions • Epidermolysis bullosa acquisita • Considerations of function, cosmesis, occur secondarily to dermatophyte • Autoimmunity against collagen and patient preference may lead to infections possibly due to VII against anchorin fibrils choosing radiation therapy as hypersensitivity reaction to the • Tense bullae similar to BP but primary treatment fungus; can occur in many forms often trauma-induced and heal • Patient selection for definitive • Histology: evidence of pustular with scarring or milia radiotherapy: BCC/SCC/In situ superficial dermatophyte infection; • EBA vs. BP • High surgical risk patients GMS demonstrated numerous • EBA: subepidermal cleavage • Postoperative management: perineural/ fungal hyphae • DIF linear IgG and or C3 vascular invasion, positive or close • Treatment: resolution of along BM margins, multiple recurrences, lymph dermatophyte infection • IIF: IgG/C3 at the dermal side of node metastases, “insurance” SSS (versus BP which has IgG/C3 surgeon uncomfortable • John Young, MD: Silver Falls/ Western at the epidermal side of SSS or • Cutaneous T-Cell Lymphoma, low grade University both epidermal and dermal) B-cell lymphoma, merkel cell tumors, • Trichodysplasia spinulosa • EBA has scarring/milia versus BP preoperative or postoperative sarcoma, • Exclusively seen in which has minimal to no scarring kaposis sarcoma, lentigo maligna immunocompromised patients; (inoperable cases), postop melanoma organ transplant recipients, cancer • Richard Miller, DO, FAOCD: • Keloids (post-operative ideal) patients on immunosuppressants or NSUCOM/Largo Medical Center • Contraindications chemotherapy • Cutaneous metastasis from • Pregnancy (absolute) • PE: folliculocentric papules on colonic adenocarcinoma • Scleroderma central face, ears, grow central • Patient presented with indurated, • Severe collagen vascular diseases (SLE) keratin spines/spicules erythematous plaques • Gorlin’s syndrome • Treatment: no universally accepted • Histology: atypical neoplastic cells; • Relative contraindications CK20 was positive (indicative of • Prior radiation to exact site • Reagan Anderson, DO, FAOCD: lower GI tract tumors); CKX2 • Young patients (under 60 years old) Rocky Mountain/Colorado stain was positive (indicative of GI • Non-compliant patient Dermatology Institute origin carcinoma) • Overview of radiation therapy • Germline BAP1 mutation • Rate of metastasis 4%; • Usually performed five days per • Chiefly dermal melanocytic poor prognosis week, less than three to five minutes; proliferation with desmoplastic and • Modes of metastasis: lymph/hem, painless; delivered over two to Spitzoid features, consistent with a direct extension, implantation six weeks melanoma of at least 1.3mm deep following surgery • Fractionation: dividing course of • Six months later: PET/CT revealed • Location: most commonly therapy into smaller pieces; small dose mass on left kidney; diagnosis of on abdomen each day rather than single large dose. clear cell renal cell carcinoma Radiation damages cellular DNA. • Two years later: had red-brown • Vernon Mackey, DO, FAOCD: Normal cells can repair DNA damage papule on upper back biopsied Advanced Desert Dermatology more effectively than cancer cells • Found to have germline mutation • Radiation induced eruptive • Penumbra: importance of adding of BAP1 tumor suppressor gene keratoacanthoma (KA) margin to lesions to account for [BRCA 1-associated protein-1 • Treatment options: surgery/ pathologic characteristics of lesion (BAP1)] radiation: radiation chosen due to

Page 16

• Definitions of therapy beams • HS: • Grenz rays (10-30 KV) • Adalimumab: recently received indication for hidradenitis • Superficial x-rays (35-200 KV) suppurativa; different dosing plan than for psoriasis • Orthovoltage (200-500 KV) • Psoriasis • Megavoltage (1000-2000 KV) • Biologics: still good safety data; still not using enough of them • Superficial/orthovoltage units for our patients • Pros: Relatively inexpensive, small footprint, minimal • Apremilast: indicated for plaque psoriasis; inhibitor of shielding needed, basic operation, can hypofractionate phosphodiesterase 4 and also of TNF-alpha in synovium; • Cons: Best for superficial lesions, limited field sizes/shapes, many side effects in beginning (nausea, vomiting, weight loss, high surface gradient dose diarrhea, headaches, and worsening of depressed mood) • Megavoltage • Secukinumab: inhibitor of interleukin-17A; Side effects (check • Pros: Long term data, can treat deep lesions for TB, infections especially yeast, exacerbation of Crohn’s • Cons: Expensive, size, team needed, patients usually need 15- disease, latex allergy); third or fourth line agent currently 30 daily visits • Atopic dermatitis • Brachytherapy • Topicals: PDE 4 inhibitors; JAK inhibitors • Radiation close to source • Oral PDE inhibitor • Remote after loader brachytherapy: radiation comes out when • Dupilumab which blocks IL4 an 13; has effect clinically and you are not in the room at molecular level • Electronic brachytherapy • Cutaneous oncology • Acts like superficial machine; emerging data • Melanoma • Pros: inexpensive, minimal shielding required; can cover most • Nivolumab (PD-1) which is part of the checkpoint small lesions inhibitors (pembrolizumab) AND iplilimumab as part of a • Cons: scarce data; disposable sources; not covered by combination therapy insurance in most states; financial burden on health • BCC care system • Sonidegib oral treatment for locally advanced BCC • Same hedgehog pathway as vismodegib Therapeutic Update • Sonidegib study is BOLT John Minni, DO, FAOCD • Vismodegib study is STEVIE • Rosacea • AKs • Topical ivermectin • Ingenol mebutate: new warning about severe reactions with • Indicated for inflammatory lesions of rosacea the use of ingenol mebutate when not used correctly • Immediate and long term efficacy • Alopecia • Excellent vehicle which boosts its anti- • Female patterned: spironolactone inflammatory benefits • Onychomycosis • Significant improvement over metronidazole cream • Efinacazole topical: not very effective • Brimonidine • Tavaborole:MOA leucyl-tRNA synthetase inhibition • For persistent facial redness of rosacea • Urticaria • Alpha 2 adrenergic agonist which leads to • Omalizumab: indicated for chronic urticaria not responsive peripheral vasoconstriction to antihistamine therapy and indicated for allergic asthma. • Rebound can be great in some Results were good • Rosacea summary • No issues getting covered • Extended release doxycycline or doxycycline 20 bid • Cosmetics • Various topical treatments: dapsone, metronidazole gel, • BellaFill: bovine collagen and polymethylmethacrylate: first azelaic acid, sulfur based therapies to be indicated for correction of acne scars on face in patients • Treat seborrheic dermatitis as well under 21 years old • Be sure to examine for atopic dermatitis in patients as this will aid in vehicle of their choice Urticarial Dermatitis: Urticaria or a Mimicker? • Acne Carlos Nousari, MD • Adapalene and benzoyl peroxide indicated for acne vulgaris • Urticarial dermatitis • Antibiotic use: for most patients a sub-antimicrobial dose • Erythematous-edematous papules and plaques; very pruritic of oral antibiotics should be used. If patient is on antibiotic • BUT consider duration, dyspigmentary changes, for more than three to six months, a new regimen should constitutional/extracutaneous symptoms, clinical and lab signs be sought • If interpretation: real vs. artifact; relevant vs. irrelevant; specific • Minocycline: Side effects include dizziness, pigment vs. nonspecific alterations, auto-immune hepatitis, drug induced lupus • Chronic urticaria • Doxycycline: Side effects include photodermatitis, nausea/ • Polymorphonuclear predominant (neutrophilic) vomiting • Papular urticaria • Sulfamethoxazole/Trimethoprim: Side effects include life • Pruritic lesions lasting longer than 72 hours threatening drug eruption, contraindicated with methotrexate • With or without dyspigmentary changes • Urticarial phase of bullous pemphigoid

Page 18 AOCD Call For Papers We are now accepting manuscripts for publication in the upcoming issue of the JAOCD. J‘Information for Authors’ is available on our website at www.aocd.org/jaocd. Any questions may be addressed to the editor at [email protected]. Member and resident member contributions are welcome. Keep in mind, the key to having a successful journal to represent our College is in the hands of each and every member and resident member of our College. Let’s make it great!

- Karthik Krishnamurthy, D.O., FAOCD, Editor • Extremely pruritic; lesions last much longer than 72 hours, • American Academy of Dermatology Association (AADA) sent increased IgE and moderate eosinophilia; lack of C3 4932 emails to their Representatives and Senators since March deposition; DIF can be negative • SkinPAC • False negative traditional DIF can be reduced to 5-10% by: • AAD Political Action Committee • Performing a perilesional rather than lesional biopsy • Katie Jones (Assistant Director) • Increased concentration of probing • Prescription drug costs • IgG4: unique IgG- also Th2; IgE does not fix complement, it • Dermatology, along with rheumatology, is on the top upregulates IgG4 end of specialties where prescription drugs will take the • Bullous pemphigoid greatest hit in the number of drugs that will be able to be • Namely early, prodromal, urticarial, eczematous phase successfully prescribed • Screening for both isotypes IgG and IgE class autoantibodies: • How do we get this to change? DIF, IIF, ELISA; provides a better diagnostic yield • Public outcry • Role of IgE directed therapy: anti-IgE monoclonal • Ironically, our allies are lawyers antibody combined therapy to reduce exposure of systemic • Access to prescription drugs on the state level corticosteroids to BP patients • AADA is an active member of the State Access to Innovative • Hypocomplementemic urticarial vasculitis syndrome (HUVS) Medicines (SAIM) Coalition • Clinically resembles Sweet’s (large urticarial plaques on • SAIM Coalition’s purpose the trunk) • Pursue step-therapy model legislation • 30% full blown and 70% smoldering SLE. Anti • Pursue legislation that limits prescription drug out-of- C1q antibodies pocket-costs • Neutrophil predominant vasculitis of dermal small blood vessels • AADA established a Drug Pricing and Transparency Taskforce • Schnitzler syndrome • Examining the issues of drug pricing and transparency • Neutrophilic urticaria • Identifying partners for collaboration • Monoclonal gammopathy (IgM>IgM) • Advocating for achievable outcomes to help patients access • Periodic fever needed treatments • Hyperostosis, arthralgias • Treatment Biologic Psoriasis Update • Lymphocyte predominant Brad Glick, DO, FAOCD • anti-H1 + anti-H2 + anti-leukotriene • Across all treatments with Psoriasis Longitudinal Assessment and • + Low dose cyclosporine or sirolimus Registry (PSOLAR), patients had a cardiovascular history; major • OR + omalizumab adverse cardiovascular events don’t appear to be an issue • Polymorphonuclear predominant • Drug survival: may predict treatment success • Anti-H1 + anti-H2 + anti-leukotriene + anti-neutrophilic: • Ustekinumab has better adherence and has greater persistence colchicine/dapsone • ERASURE trial (secukinumab): good persistence of drug • Urticarial bullous pemphigoid displaying Psoriasis Area and Severity Index (PASI) 75 at the end • Prednisone +/- mycophenolate mofetil/sodium +/- of 50 weeks (some fall off at 50 weeks; higher at 12 weeks) rituximab +/- omalizumab • FIXTURE (etanercept comparator trial): robust data; but • HUVS inferior to secukinumab • Prednisone +/- mycophenolate mofetil/sodium +/- • TRANSFIGURE trials: 198 patients with plaque psoriasis with • Schnitzler syndrome nail psoriasis; showed improvement in nail psoriasis for patients • Anti-H1 + anti-H2 + anti-leukotriene + colchicine/dapsone on secukinumab thalidomide/lenalidomide +/- anakinra • GESTURE: palmoplantar psoriasis improved on secukinumab • Tofacitinib: fairly long time to relapse (approx. 16 weeks); Osteopathic Dermatology in an Allopathic World retreatment with drug returned patients to PASI 75 Mark Lebwohl, MD • Tofacitinib is an effective agent; has some risk with infections • A single unified voice provides a stronger advocacy positioning • Ixekizumab: IL-17A inhibitor; 75-100 mg is optimum dosage. for anything that we do Side effects rare but include upper respiratory tract infections. • About the AAD and Why It is Important to Participate 52-week open-label study where patients received treatment • The AAD plays advocate to a large amount of legislation that every four weeks with almost 50% of patients resulting in takes place in Washington D.C. clear skin • SGR repeal • Brodalumab (IL-17 receptor antibody inhibitor): treats severe • AAD encouraged members to write to congress psoriasis. Very durable drug • Global period codes • Anti IL-23: tidrakizumab and guselkumab (fully human • Estimated that dermatologists would lose about $100,000 monoclonal antibody against IL-23; 50-100 mg is ideal each if this ‘Global Period Codes’ were removed treatment). Show PASI improvement • How it was stopped • Golimumab and certolizumab approved for RA and may be • Representative Larry Bueshon, MD (R-Indiana) and approved for psoriasis in near future Representative Ami Bera, MD (D-CA) • Biosimilars: are not chemically identical to biologics; offer • Bipartisan letter signed by 53 Representatives to Boehner potentially affordable treatments. Infliximab: psoriatic arthritis and Pelosi and psoriasis

Page 20 • JAK kinase inhibitors: baricitinib in the future • Features of good consent • Adenosine CF 101 inhibitors in the future • Gives patient information to make good decision • Individualized The Best Malpractice Defense -- Informed Consent • Stated in plain language Clifford Lober, MD, JD • Patient had opportunity to ask questions, and they have been answered to satisfaction • Documented • Informed consent exceptions: emergency exception, “extension doctrine,” therapeutic privilege, waiver • Informed refusal • A competent patient has the right to refuse any and all medical care

What to do when things go horribly wrong Clifford Lober, MD, JD • Anticipate the possibility: appropriate training, compliance with office surgery rules, informed consent, rapport with colleagues, dismiss appropriate patients • How do I deal with the patient? • Check the facts • Do everything you can to be available • Intentionally show concern, compassion, and empathy • Do not deny responsibility but absolutely never • A surgeon who performs an operation without patient’s consent • admit liability performs an assault on patient’s body • Always be honest • Fundamental right of self-determination regarding decisions • Reiterate need for procedure and any positives outcomes pertaining to his or her own health, including the right to if appropriate choose or refuse medical treatment • Clear up misunderstandings • CONSENT: an agreement to undergo a procedure made by a • Mitigate damages person who has the capacity to give agreement • Consider offering a second opinion • INFORMED: person giving consent has the knowledge of the • Inform your malpractice insurance carrier reasonable alternatives available, including doing nothing, and • Retain health care attorney the possible complications of each; informed consent is a process • Should you apologize? • It is NOT a signed sheet of paper • It depends--do you come across as sympathetic or arrogant? • No consent = battery • “Apology laws” prohibit expressions of regret, sympathy, or • This is a civil and criminal offense benevolence from being entered into evidence. Document • Legally deficient consent = negligence apology in the chart • What should be in a consent? • Duty to notify a patient: timely, proper setting, accurate • Not every complication needs to be disclosed as this may information, factual, responsive, document overwhelm the patient • Medical records: never alter the records; never release original • Postulates regarding informed consent: records--send copies; personally review what is sent out of 1. Assume knowledge of patient and physician are not in parity your office 2. Adults in sound mind has the right to determine whether or • Dealing with yourself: discuss situation with attorney; not they will consent consider psychological counseling if emotional response 3. Patients must know alternatives to consent to treatment is strong or persistent. Be careful of how you discuss with 4. Patient has an abject dependence upon the physician that spouses and colleagues transcends arms-length transactions • Should disclose all information relevant to making a meaningful decision (such as information that particularly applies to patient; potential for treatment ending in severe disability or death; and what a skilled practitioner of good standing would provide under similar circumstances • Specific consent requirements (ex. California requires specific consent for collagen injections) • Who should obtain consent? • It is the responsibility of the physician to explain the procedure and obtain the informed consent of the patient • Cosmetic patients: “promise less and deliver more” • Consent is not release from duty; procedure must still be done the correct way

Page 21 New Updates in Pediatric Dermatology • Eclipse nevi: benign and common but often biopsied because Lisa Swanson, MD of atypical coloring • Atopic dermatitis • Congenital melanocytic macules of the tongue: observe as benign • Standard treatment: sensitive skin care; topical steroids • Alopecia areata treatments • Scalp options: DermaSmoothe oil at bedtime; clobetasol foam • Pulse IV methylprednisolone • Steroid sparing agents: Tacrolimus-generic; Elidel-philidor; • Low dose IL-2 black box warning (newest studies show no association • Fexofenadine between malignancy and pimecrolimus; patients with atopic • Tofacitinib being examined currently in two studies dermatitis have slight increased risk of lymphoma) • Ruxolitinib being used in current trials • Natural therapy: coconut oil (has good antibacterial properties • Nails but doesn’t seem to help with eczema itself); sunflower seed oil • 20 nail dystrophy of childhood: 82% improve over time but (does seem to help with eczema) some can persist up to a decade • Prevention of atopic dermatitis: • Pediatric onychomycosis: evaluate for tinea pedis; treat with 1. If pregnant woman takes probiotics two weeks prior to terbinafine for three months having baby and for three months after having the baby, it • Vascular lesions reduces the risk of eczema in that baby by 20s-30s. • Port wine stains: GNAQ gene mutation; pulsed dye laser 2. Vitamin D: patients with vitamin D had more treatment can cause permanent alopecia; topical rapamycin + staph colonization pulsed dye laser is most promising combo but cost of topical • New therapies: AN2728 (boron based ointment); oat prep is an issue based sterile emollient cream • Hemifacial V1/V2 is most common site for port wine stain • New therapies: Topical tofacitinib (JAK one-third • Capillary malformation arterovenous malformation syndrome: inhibitor); cyclosporine weekend therapy; dupilumab RASA1 gene mutation; autosomal dominant; ultrasound any (anti-IL-4) large or growing malformations • Allergic contact dermatitis • Patients should see neurologist, cardiologist, and orthopedist • Wet wipe dermatitis; Easter egg hunt dermatitis (nickel for evaluation in chocolate) • Infantile hemangiomas: propranolol is still helpful but note • Psoriasis that it can cause hypoglycemia • Topical steroids continue to be mainstay. Etanercept • Typically used during proliferative stage approved in US for kids with juvenile idiopathic arthritis • Pyogenic granulomas: timolol provided great results with (JIA) over two years; adalimumab is approved in US for clearance after two to three months with the bleeding kids with JIA over two years old and Crohn’s over six stopping instantly years old • Important to follow up to ensure improvement (as Spitz • Paradoxical psoriasis in kids on TNF inhibitors nevi and melanoma are on differential) • Molluscum • Genodermatoses • Published on quite a bit this year • Neurofibromatosis I: nevus anemicus is newly discovered • No difference between treated and untreated groups in feature; tends to be on chest recent study • Rapamycin: mTOR inhibitor; has immunosuppressant, anti- • Imiquimod works; candida works proliferative, and antiangiogenic properties • Pseudofurunculoid molluscum: sign of 2015 Fall Meeting State and Regional Attendance Breakdown immune system response to molluscum • Acne • Occurring in younger patients (now abnormal if it appears before seven years old) • Mid-childhood acne: one to seven years old; order labs (total and free testosterone, DHEA-S, LH/FSH, bone age) • Food and acne: diet with low glycemic index can help; probiotics are likely helpful (probably works by decreasing inflammation) • Moles

Page 22 • Vitiligo • Treatment: alitretinion, cryotherapy, radiation therapy, • Rapidly progressive vitiligo: can treat with three weeks of oral intralesional vinblastine, local excision, chemotherapy prednisone to stop the flare • Segmental vitiligo: excimer laser + protopic + short term oral What is an Osteopathic Dermatologist Anyway? steroids yielded best results Reagan Anderson, DO, FAOCD and Teodor Huzij, DO, FACN • Rashes • Lichen sclerosus: doesn’t go away for most girls after puberty; treatment with clobetasol ointment bid for two weeks then once daily for two weeks, then follow-up; repeat course if needed until clear; then clobetasol MWF once daily for maintenance • Hand foot and mouth disease: Coxsackie A6 is new primary causative agent; produces more severe rash • Morphea: can mimic acquired port wine stain (very rare) • Mycoplasma associated SJS/EM Major: oral steroids are better than IVIG • Pigmented purpuric dermatoses: most common is Schamberg’s purpura; idiopathic and treatment is difficult; self-limiting but can treat with topical steroids and UV light • Herpes zoster: seen in children younger and younger • Hemorrhagic edema of infancy: impressive rash but not serious; likely virally triggered; juicy red papules and plaques on face and • It is important as osteopathic dermatologists to not forget our distal extremities; self-limiting but can treat with prednisone osteopathic training. Some DOs don’t always use the osteopathic • Hyperkeratotic lichenoid papules of elbows and knees: kids philosophy in their practice outgrow it; can treat with AmLactin • The osteopathic principles to remember are • Spots • The body is a unit; the person is a unit of body, mind, and spirit • Pilomatricomas: very common calcifying cysts; due to gene • The body is capable of self-regulation, self-healing, and mutation in CTNNB1 which encodes beta-catenin; positive health maintenance teeter totter sign • Structure and function are reciprocally interrelated • Cranial dysraphism: any subcutaneous growth on head of • Rational treatment is based upon an understanding of infant can raise suspicion for this the basic principles of body unity, self-regulation, and the • Lumbosacral dysraphism interrelationship of structure and function • Actinic Keratosis Larkin Community Hospital Grand Rounds Cases • Keep in mind the psychosocial components a patient with any Francisco Kerdel, MD dermatological condition might experience: • To share a case at grand rounds, email [email protected] • Depression, anxiety, lack of confidence. • Pyoderma gangrenosum • Consider a patient’s experience as they go on a date, have a job • Incidence is unknown; trauma can aggravate or produce a interview, or large family function new lesion • Treatments as they apply to the osteopathic principles • Clinical variants: ulcerative (most common), pustular, • Cryotherapy: inducing localized destruction encourages the bullous, vegetative body to initiate its self-healing mechanisms • Pathergy can develop • Light and field therapy: Certain medications or approaches • Most common site is lower extremities will modulate the immune system in a way that encourages • Therapy: compresses/antibacterial agents/occlusive dressings; self-healing and works on the actual problem, rather than topical/intralesional steroids; cromolyn 2-4%; benzoyl just symptoms peroxide; radiation; grafts; TOC cyclosporin • Psoriasis • Infliximab is possible treatment option • Immune modulators encourage the body to initiate its own • Use of maggots to debride necrotic tissue (don’t leave dressing self-healing mechanisms on for longer than 48 hours) • Acne • Gevokizumab (IL-1 beta inhibitor) • Antibiotics don’t fully consider the osteopathic principles. • Dermatomyositis They are temporary solutions and don’t treat the underlying • Treatment: mycophenolate mofetil structure and function pathology (keratinization and • Generalized lichen sclerosis et atrophicus prevention of oil motility). They are still good treatment • New therapeutic options: excimer laser, PDT, acitretin options for short term, but consider longer-term options • Intravascular B-Cell Lymphoma • Low glycemic index, (and possibly less dairy use) are more in • RCHOP; rituximab as both initial and salvage therapy line with an osteopathic approach to treatment • Follicular center cutaneous b-cell lymphoma • Keep the osteopathic philosophy in mind as you treat patients • Treatment with excimer laser; other possibilities include • Think of the mechanisms of action of your treatment approaches interferon alfa injections, rituximab, chlorabucil • Think if there are other treatments that are more in line with our • Kaposi sarcoma osteopathic training

Page 23 Foundation for Osteopathic Dermatology Update

The Foundation for Osteopathic The FOD Resident Research Grant Dermatology is accepting applications is awarded annually to an osteopathic for research grants. Click here to visit the dermatology resident in an AOA-accredited Foundation page for more information. institution. The purpose of this grant is to foster research in dermatology medicine The FOD instituted a research grants conducted by dermatologists at a program to encourage and support scientific graduate level. investigations into the potential causes of dermatological issues and other key aspects The FOD Young Investigator Grant of various dermatological conditions. is awarded annually to an osteopathic Research grants are provided to encourage dermatologist who is a graduate of an improvement in its treatment, potential accredited dermatology residency and prevention and/or cure in the related practicing dermatology in an accredited dermatology field. institution for five years or less. The purpose of this grant is to foster research among Applications will be entertained from young dermatologists and is awarded to osteopathic physicians in postdoctoral promising physician researchers meeting Introduction: Include description of training programs and research fellowships these criteria. the general concepts of the project, in dermatology. Each grant supports one background information, preliminary individual. Not more than two consecutive The FOD Physician Investigator Grant work and observations or reference to or non-consecutive grants may be awarded to is awarded annually to an established existing literature; an individual. osteopathic physician with five or more years 5. Major Methods: A detailed description in practice, who is certified in dermatology of the research plan including methods The grant is not exclusive and the investigator and conducting research in dermatology at and controls. Include a description of the may seek additional funding from other an accredited institution. The purpose of this proposed experiments or procedures; the sources such as the AOA Bureau of Research, grant is to sponsor or co-sponsor research in techniques to be used; the number and governmental agencies, other outside any area of dermatology. type of subjects; the control population; agencies, college or hospital, etc. the types of data expected to be The FOD Institutional Grant is awarded generated; and the means by which the All requests for grants are submitted in to an osteopathic physician who is certified data will be analyzed and interpreted; accordance with established guidelines and in dermatology and providing care in a 6. Analysis of Results: Present an overview deadlines for the individual grants and are developing country. The purpose of this of the planned analysis and summary of subject to review by established procedures grant is to sponsor a dermatologist helping the data; of the Board of Directors of the Foundation. to improve the dermatologic needs of that 7. Conclusion: Provide a description of the All areas of dermatology research will be specific country. significance of this research to the field of considered based on their scientific merit. dermatology and osteopathic medicine Researchers interested in applying for a Submission Information (philosophy or practice) in general; research grant can download the application Applications must be typewritten or printed 8. Project Summary: The summary should from the American Osteopathic College of and contain all of the following: provide a concise overview of the project Dermatology’s website. 1. Curriculum vitae: Limited to four (limited to one page). pages. Include the following, listed There are multiple grants available to an in chronological order: employment, Incomplete applications will not be accepted. osteopathic dermatologist. They include: positions and honors, selected peer- Applications received after the deadline date reviewed publications (do not include will be returned unread. publications submitted or in Applications must be received by December preparation), research 31 of each year to be eligible for consideration. experience; 2. A photo portrait Applications for research grants are reviewed (head and shoulders) for validity and efficacy by the Board of Our Goal Is Clear of the applicant; Trustees of the Foundation. The Board will 3. Budget: A budget determine the selection of grant applicants detailing how the and the amount of grant monies allocated funds will be used; based on funds available in the grant Visit booth 261 4. Research category. All applicants will be notified of AU95810 03/2015 PRINTED IN USA ©2015 LILLY USA, LLC. ALL RIGHTS RESERVED proposal containing the receipt of their application within ten the following: days by the executive director.

Page 24 Dr. Smirnov Attends Annual AAD Legislative Conference Brittany Smirnov, DO, a Applicants receiving grants for any of the programs second-year resident at described in this brochure will receive their grant monies the NSUCOM/Broward in two or more payments. At the end of the fiscal year, Health Medical Center appropriate tax forms such as a 1099 will be sent. dermatology residency, under the direction of Applicants will be ineligible to apply for subsequent grants Carlos Nousari, M.D., for one year after receiving a grant. received a scholarship to attend the AAD’s annual Grant recipients are required to submit a report after 6 legislative conference in months and upon completion of the project as well as a Washington, DC from Dr. Smirnov with patient advocates Amy and Gracie. September 27-29, 2015. full reconciliation of funds dispersed. This year the conference welcomed a record 177 attendees, with 132 physicians, 18 residents, 31 members of the coalition of skin diseases and The Foundation for Osteopathic Dermatology members seven patients with rare diseases. are Brad Glick, DO, Eugene Conte, DO, Gregory Papadeas, DO, John Minni, DO, Dwayne Montie, Participants attended preparatory lectures and symposia led by DO, Bryan Sands, DO, Jon Keeling, DO, Suzanne Washington insiders and politicians, including political analyst Stu Sirota Rozenberg, DO, and Marsha Wise, AOCD Rothenberg, Congressman Frank Upton (MI) and keynote speaker, former White House correspondent Ann Compton. Local and state Executive Director. organized groups of advocates engaged in over 212 meetings, 143 house and 69 senate, with congressional officers and their staff. The Foundation approved the following grants in 2015: Attendees, physicians and patients alike advocated on behalf of the • “Autoimmunity in Primary Cutaneous Lymphoma dermatologic profession for legislation to improve patient access to and Pseudolymphoma” care, pharmaceuticals and improved funding for general health and skin Stephen Delost, Case Western Reserve Hospital, cancer research. Cleveland, OH • “Dermoscopy Research” In her own meetings, Dr. Smirnov worked with fellow dermatologic colleagues from across Florida, meeting with the staffs of Florida Senators Alexis Stephens, DO Marco Rubio and Bill Nelson, as well as Congresswoman Lois Frankel. • “Genomic Characterizations of Melanomas in the As a scholarship recipient and resident-level donor to SkinPAC, the Hispanic Population” dermatologic non-partisan political action committee, Dr. Smirnov had the Karthik Krishnamurthy, DO opportunity to attend a lecture by physician and senator Bill Cassidy (LA). • “A Randomized, Double-blind, Multicenter Study of the Efficacy and Safety of AbobotulinumtoxinA Dr. Smirnov felt the legislative conference was an important opportunity Reconstituted up to 10 Weeks Prior to Injection” to learn about the current and upcoming issues facing dermatology and provided an excellent opportunity for physicians, residents and patients to Matthew Zarraga, DO become more familiar with and active in the political processes that affect the profession. Recently the Board of Trustees of the Foundation approved a new level of giving. The Pinnacle Table joins the already established levels of the Ulbrich Circle, the Koprince Society, the Leaders of Osteopathic Dermatology, the Scholars Circle and the Resident’s Forum. NSUCOM/Broward Health Medical Center Residents Visit Rural India on Medical Mission Become a donor to one of the fastest growing In November 2015, four residents from the NSUCOM/Broward Foundations in Osteopathic Medicine, the Foundation Health Medical Center dermatology residency program traveled to for Osteopathic Dermatology! Through your pledge, northwestern India on a dermatologic medical mission. Third-year the Foundation can achieve its’ goals of providing public resident Alexis Stephens, DO and second-year residents Brittany health information, funding research and charitable Smirnov, DO, Jennifer contributions! We can only do it with your support of a Conde, DO and Brandon tax-deductible donation. Nickle, DO, visited the rural villages of Rajasthan, Categories Available: India, outside of Udaipur, • Pinnacle Table $25,000 where they treated ($5000 per year over a five year period) 3,400 patients with other providers over the course • Ulbrich Circle $10,000 of five days. Diseases ($1000 per year over a ten year period) encountered included • Koprince Society $1000 xerosis, pediculosis capitis, • Leaders of Osteopathic Dermatology $500 Clockwise from bottom: Drs. Alexis Stephens, Brittany Smirnov tinea corporis and capitis, and Jennifer Conde with local school children. • Scholars Circle $250 bullous impetigo, lichen • Residents Forum $100 planus, chronic actinic dermatitis and many other cutaneous conditions. During their time in rural Rajasthan, they also worked and talked with The Foundation also updated its by-laws.Click here to local school children, helping to build the foundation of education and view the recently revised by-laws. encourage life-long learning. Page 25 Corporate Spotlight By Shelley Wood, MaE, Administrative Grants Coordinator Corporate Sponsors Support Fall Meeting

I appreciate having had the Novartis Pharmaceutical, Promius Pharma, Sensus Healthcare, Sun opportunity to thank several of Pharma, Inc., Syneron/Candela, Taro Pharmaceuticals USA, Inc., our corporate sponsors for their Topix Pharmaceuticals, and Valeant Pharmaceuticals. continued support of the College and to welcome new exhibitors at the We hope that many of you had an opportunity to express your 2015 Fall Meeting. All the exhibitors appreciation to our sponsors while you were in Orlando. The where happy with the layout of the fact that they continue to support the College, many of them room and the time spent with the doing so for several years, speaks volumes about the value of their attendees. I have received positive commitment to our organization. feedback from several exhibitors. The AOCD is very fortunate to have corporate sponsors who join us as New Fall Meeting Exhibitors – Orlando, FL partners with a commitment to medical excellence. Our corporate Genentech – Considered the founder of the industry, Genentech, sponsors remain committed to the College and continuing medical now a member of the Roche Group, has been delivering on the education (CME). It goes without saying that our corporate promise of biotechnology for over 35 years. Genentech became sponsors are critical to helping us accomplish our mission. a member of the Roche Group in March of 2009. As part of their merger agreement, Roche and Genentech combined their New and returning corporate sponsors are as follows: pharmaceutical operations in the US. Genentech’s South San • Galderma, Sun Pharma, Valeant Pharmaceuticals (Diamond Level) Francisco campus now serves as the headquarters for Roche • AbbVie, Celgene, Merz Pharmaceuticals, LLC (Gold Level) pharmaceutical operations in the US. Genentech Research and Early • Lilly USA, LLC (Silver Level) Development operates as an independent center within Roche. • Anacor Pharmaceuticals, DLCS (Bronze Level) • Actavis, plc, Allergan, Dermpath Diagnostics, DUSA Genentech is a leading biotechnology company that discovers, develops, Pharmaceuticals (Pearl Level) manufactures and commercializes medicines to treat patients with serious or life-threatening medical conditions. We are among the In addition to corporate membership, Sun Pharma, has had a long world’s leading biotech companies, with multiple products on the relationship with the College and continues to support us through market and a promising development pipeline. Their website is: generous sponsorships. Sun Pharma’s most recent sponsorship was http://www.gene.com/. for the Presidential Celebration that was held Friday, October 16, 2015 at the Wantilan Pavilion. The Presidential Celebration gives IntraDerm Pharmaceuticals - IntraDerm is a specialty exhibitors and physicians the opportunity to meet in an informal pharmaceutical company focused on innovative technologies and setting. We appreciate everything Steve Hecklein and Sun Pharma is drug delivery platforms. Our mission is to develop high quality doing for the College and CME. dermatological products that are affordable and accessible to most every patient. Their website is:http://intraderm.com/ . Dermatopathology Labs of Central States (DLCS) sponsored our meeting t-shirts and bags. Medimetriks Pharmaceuticals, Inc. Medimetriks is a leading independent specialty pharmaceutical company dedicated to LEO Pharma sponsored our meeting lanyards. Lilly USA, LLC Dermatology and Podiatry markets. Medimetriks is committed sponsored the Resident Research Paper Competition. Dermpath to advancing patient care through the development, licensing and Diagnostics sponsored a resident dermatopathology review with commercialization of innovative prescription skin care brands that Dr. David Barron. Allergan and Valeant Pharmaceuticals provided fill unmet needs in the markets we serve. Medimetriks current support by way of unrestricted grants to helps support the meeting. portfolio of brands, which are promoted by our national sales force, The AOCD is grateful for the continued support from these treat conditions including acne, rosacea, atopic dermatitis, fungal companies in making our meetings a success. infections, dystrophic nails and impetigo. Medimetriks is experts in commercialization, including creating brands, maximizing life cycles The AOCD also appreciates the following company for providing and generating value for biotech, generic and other development breakfast Product Theater, Lilly USA, LLC. The breakfast lecture companies that may benefit from the depth and breadth of our was given by Dr. Brad P. Glick on Friday, October 16, 2015. Dr. relationships in Dermatology and Podiatry. Their website is: Glick spoke on The Pathophysiology of Psoriasis and the Role of the IL- http://www.medimetriks.com/. 17 Family. Sensus Healthcare – At Sensus Healthcare, we are devoted to Exhibitors for the 2015 Fall Meeting were as follows: AbbVie, making a difference in the lives of people who suffer from non- Allergan, Aqua Pharmaceuticals, Aurora Diagnostics, Bayer melanoma skin cancer and unsightly keloid scarring. By designing Healthcare, Capillus, LLC, Celgene, Dermpath Diagnostics, DLCS, and manufacturing safe and reliable state-of-the-are superficial DUSA Pharmaceuticals, Elekta, EZDERM, Galderma, Genentech, radiation technology right here in the US, we are providing Heartland Payment Systems, IntraDerm Pharmaceuticals, compassionate dermatologists and oncologists around the world Janssen Biotech, Inc., Leo Pharma, Lilly USA, Inc., Medimetriks with a non-surgical treatment option that empowers them to cure Pharmaceuticals, Merz North America, Modernizing Medicine, patients without compromising patient confidence, dignity or

Page 26 quality of life. Their website is: quality, pharmaceutical grade ingredients; representatives are committed to providing http://sensushealthcare.com/. manufactured and tested to deliver safe, ongoing training, service and support for effective, results for all patient skin types. dermatology and plastic surgery skin care Topix Pharmaceuticals - For over 30 Topix chemists closely monitor and control specialists. Topix offers an extensive product years, Topix Pharmaceuticals Inc. has each step of product development and portfolio which provides physicians with remained dedicated to excellence, beginning manufacturing in our state-of-the-art, numerous product options, enabling them with the research and development of FDA registered manufacturing facility. the ability to provide “patient skin-type” quality skin care formulations. Topix Our outstanding skin care professional and “condition driven regimens.” Their products are developed using the highest sales department and customer service website is: http://topixpharm.com/.

2016 AOCD Spring Meeting March 31 - April 3 | Ritz Carlton Battery Park | New York, NY Invited Speakers and Topics Surgical Repair Panel Effective Therapies in Melanoma Superficial Radiotherapy Updates Reagan Anderson, DO & Anna Pavlick, DO David Herold, MD Michael Whitworth, DO Cosmetic Dermatology Medicare Fraud and the False Claims Act Allergic Contact Dermatitis: North American Suzanne Sirota Rozenberg, DO Ted Schiff, MD Standard Series, Parts 1-3 Occupational and Environmental Dermatology Dermatology Rheumatology Peter Saitta, DO David Cohen, MD Adam Friedman, MD Psoriasis Co-Morbidities Interesting and Educational Pediatric Dermatology Jerry Bagel, MD Dermatological Cases Sourab Choudhury, DO Answers to Your Questions Stephen Purcell, DO Manifestations and Treatment of About Psoriasis Atopic Dermatitis Update Cutaneous Venous Hypertension Mark Lebwohl, MD Brad Glick, DO Ronald Bush, MD Dermatopathology Update Adherence to Treatment Dermatopathology Amy Spizuoco, DO Steve Feldman, MD Michael Nowak, MD Pearls of Group Practice Therapeutic Update Challenging Dermatologic Therapies Steven Grekin, DO James Del Rosso, DO and Management Joseph Jorizzo, MD Use of PA’s in Successful My Approach to Cosmetic Dermatology Dermatology Practice Laura Benedetto, DO John Minni, DO & Jeff Johnson, PA

Click here for complete meeting schedule and lecture times Residents Update By John Grogan, Resident Coordinator Hello everyone, Grand Rounds Online Each residency program, once again, is asked to provide a case for It was great to see all the second- and the Grand Rounds website. The 2016 schedule is as follows: third-year residents again and to meet our new residents. I hope you • January 5, 2016 enjoyed the lectures and had a great • OPTI-West/Chino Valley Medical Center time catching up with friends and • February 5, 2016 networking with new colleagues. • LECOM/Alta Dermatology • Northeast Regional Medical Center Many people put in a lot of time and • March 5, 2016 work to make this meeting all that it • Lehigh Valley Health Network was. Thanks to Dr. Alpesh Desai and • University Hospitals Regional Hospital Marsha Wise for the many hours they spent putting together the • April 5, 2016 program. A special thanks to our wonderful student ambassadors for • O’Bleness Memorial Hospital the Fall Meeting, Laura Jordan, DO; Brandon Basehore, OMS-IV; • Botsford Hospital and Shane Swink, OMS-II. Each was instrumental in allowing us to • May 5, 2016 accommodate over 500 attendees at the meeting and went above and • Oakwood Southshore Medical Center beyond what was asked. We couldn’t have asked for a better team. • West Palm Hospital • June 5, 2016 2016 Resident Membership Renewal • St. Barnabas Hospital With a new membership year approaching, it’s not too early to begin • St. John’s Episcopal Hospital thinking about renewing your annual dues. These can be paid online • July 5, 2016 through your member account at www.aocd.org. You can quickly and • NSUCOM/Largo Medical Center conveniently renew your membership online using these five easy steps: • UNTHSC/TCOM 1. To get started, click sign in at the top of the homepage. • August 5, 2016 2. Enter your username and password, and click sign in. [Note: • PCOM Mednet/North Fulton Hospital Medical Campus If this is your first time signing in, you will be taken to a • OMNEE/Sampson Regional Medical Center screen prompting you to verify your member profile options. • Palisades Medical Center Make any desired changes, click the Save Settings button, and • September 5, 2016 proceed to Step 3.] • St. Joseph Mercy Health System 3. Click the yellow *** Renew Your Membership Now *** banner • Advanced Desert Dermatology 4. You will be prompted to update your contact information. If you • Affiliated Dermatology have any changes, enter updated information in the appropriate • October 5, 2016 field. When finished, click the Save Changes button. • NSUCOM/Broward Health Medical Center 5. Enter your billing and payment information, and click the • South Texas Osteopathic Dermatology Submit Securely button. • NSUCOM/Larkin Community Hospital • Texas OPTI/Bay Area Corpus Christi Medical Center If you have any problems logging in, please contact us and we will • November 5, 2016 help you. • LECOM/Tri-County Dermatology • OPTI-West/Aspen Dermatology In-Training Exam • MSUCOM/Lakeland Regional Medical Center You should have received your scores from the 2015 In-Training • LECOMT/Dermatology Residency of Orlando Exam at the end of November or the beginning of December. The • December 5, 2016 results are sent to all participating residents and their Program • LewisGale Hospital – Montgomery/VCOM Directors. If you have not received your results, please contact me, • WUHS/Silver Falls Dermatology and I will re-send them to you. • Colorado Dermatology Institute • CEME/Park Avenue Dermatology New Resident Liaison Named The chief resident from each program is responsible for making sure Congratulations to Lacey that a case is submitted. He or she must notify the AOCD when Elwyn, DO, the new it is submitted. Please contact me for the sign-on information to resident liaison for the submit a case. 2015-2016 residency year. Dr. Elwyn is a second-year Be sure to check out the Dermatology Grand Rounds on our website at http://www.aocd.org/?page=GrandRounds. resident in the St. Barnabas Hospital program under I hope everyone has a happy and safe holiday season with family and the directorship of Cindy friends. I hope to see you in New York for the 2016 Spring Meeting. Hoffman, DO, FAOCD.

Page 28